Effects of two personalized dietary strategies during a 2-year intervention in subjects with nonalcoholic fatty liver disease: a randomized trial
Open accessAbstract
BACKGROUND AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) management is focused on lifestyle modifications, but long-term maintenance is a challenge for many individuals. This study aimed to evaluate the long-term effects of two personalized energy-restricted dietary strategies on weight loss, metabolic and hepatic outcomes in overweight/obese subjects with NAFLD. METHODS: Ninety-eight subjects from the Fatty Liver in Obesity (FLiO) study (NCT03183193) were randomly assigned to the American Heart Association (AHA) or the FLiO dietary group in a 2-year controlled trial. Anthropometry, body composition (DXA), biochemical parameters and hepatic status (ultrasonography, Magnetic Resonance Imaging, and elastography) were assessed at baseline, 6, 12 and 24 months. RESULTS: Both the AHA and FLiO diets significantly reduced body weight at 6 (-9.7% vs -10.1%), 12 (-6.7% vs -9.6%), and 24 months (-4.8% vs -7.6%) with significant improvements in body composition, biochemical and liver determinations throughout the intervention. At the end of the follow-up, the FLiO group showed a greater decrease in ALT, liver stiffness and Fatty Liver Index, among others, compared to AHA group, although these differences were attenuated when the analyses were adjusted by weight loss percentage. The FLiO group also showed a greater increase in adiponectin compared to AHA group. CONCLUSIONS: The AHA and FLiO diets were able to improve body weight and body composition, as well as metabolic and hepatic status of participants with overweight/obesity and NAFLD within a 2-year follow-up. These findings show that both strategies are suitable alternatives for NAFLD management. However, the FLiO strategy may provide more persistent benefits in metabolic and hepatic parameters.
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Only a few studies have performed 12-24 month follow-ups, showing a maximal weight loss at 6 months, followed by a gradual weight regain to a net weight loss of about 5% at 12-24 months and partial regain of liver lipid content and stiffness.
“Only a few studies have performed 1224monthfollow-ups,showingamaximal weightloss at6 months, followed by a gradual weight regain to a net weight loss of about 5% at 12-24 months and partial regain of liver lipid content and stiffness. 286 -288”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [286]
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Angelidi, A. M., Boutari, C., Kokkorakis, M., Stefanakis, K., Mikhailidis, D. P., Jacob, G., & Mantzoros, C. S. (2026) · Endocrine Reviews · doi:10.1210/endrev/bnag023 · Cited by 6 · see citing works
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Effectiveness of Lifestyle Interventions for Nonalcoholic Fatty Liver Disease Treatment
Arredouani, A. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.106445 · Cited by 3 · see citing works
Planetary Health Diet Adherence Improves Weight and Body Composition During Energy Restriction
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Self-citationReducing complications of metabolic dysfunction–associated steatotic liver disease
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Non-Alcoholic Fatty Liver Disease (NAFLD) and Nutrition
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Akdeniz diyeti ve Non alkolik yağlı karaciğer hastalığı
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- Authors
- Marin‐Alejandre, B. A., Cantero, I., Perez‐Diaz‐del‐Campo, N., Monreal, J. I., Elorz, M., Herrero, J. I., Benito‐Boillos, A., Quiroga, J., Martinez‐Echeverria, A., Uriz‐Otano, J. I., Huarte‐Muniesa, M. P., Tur, J. A., Martinez, J. A., Abete, I., & Zulet, M. A.
- Affiliations
- Department of Nutrition Food Sciences and Physiology and Centre for Nutrition Research Faculty of Pharmacy and Nutrition University of Navarra Pamplona Spain
- Universidad de Navarra (ES)
- Navarre Institute of Health Research (ES)
- Navarra Institute for Health Research (IdiSNA) Pamplona Spain
- Complejo Hospitalario de Navarra (ES)
- Instituto de Salud Carlos III (ES)
- ORCID
- Venue
- Liver International
- Publisher
- Wiley
- Published
- 2021-03
- Volume
- 41
- Issue
- 7
- Pages
- 1532-1544
- ISSN
- 0106-9543 (ISSN-L)
- 1478-3223
- 1478-3231
- OpenAlex
- W3127576437
- Cited by
- 54
- References
- 51
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 9 · 2023: 15 · 2022: 5 · 2021: 3
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Liver International (publishedVersion)
- PubMed (publishedVersion)
- Deposito Adademico Digital Universidad De Navarra (University of Navarra) (submittedVersion, other-oa)
- Funders
- Consejo Nacional de Ciencia y Tecnología (440104/2016)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CB12/03/3002)
- Fundació la Marató de TV3 (201630.10)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- non-alcoholic fatty liver disease, personalized diet, hypocaloric diet, weight loss, obesity, body composition, liver stiffness, fatty liver index, adiponectin, long-term dietary intervention, metabolic outcomes
- MeSH terms
- Body Weight, Diet, Humans, Liver, Obesity, Weight Loss, Non-alcoholic Fatty Liver Disease
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